Healthcare Provider Details

I. General information

NPI: 1992083679
Provider Name (Legal Business Name): JEFFREY A CHUY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 W 81ST ST STE 108
BLOOMINGTON MN
55437-1111
US

IV. Provider business mailing address

4801 W 81ST ST STE 108
BLOOMINGTON MN
55437-1111
US

V. Phone/Fax

Practice location:
  • Phone: 952-837-9700
  • Fax:
Mailing address:
  • Phone: 952-837-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125059703
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number60183
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: